胰腺导管内乳头状黏液腺瘤的影像诊断

Imaging diagnosis of intraductal papillary mucinous tumor of the pancreas

目的探讨胰腺导管内乳头状黏液腺瘤患者的CT和MR影像学表现。方法收集10例经手术病理证实的胰腺导管内乳头状黏液腺瘤患者的影像资料，其中8例行CT平扫和增强扫描，6例行MR平扫和增强扫描。结果肿瘤位于胰腺头颈部8例，体尾部2例；均有主胰管扩张，管径（O．8±0．2）cm，3例合并分支胰管扩张，4例伴有胰体尾部萎缩。6例CT示囊性肿物，内有分隔和乳头状突起；2例仅见主胰管轻度扩张，内有乳头状突起。囊性肿物的囊性部分CT呈稍低密度，MRT。WI呈低信号，T2WI呈高信号，内可见等信号分隔和乳头状突起；增强示分隔和乳头可见强化。结论胰腺导管内乳头状黏液腺瘤最常见于胰腺头颈部，影像表现为胰管不同程度的全程扩张，胰腺头颈部囊性病灶，内含有乳头状和分隔结构，囊壁、乳头和分隔强化，认识其特征性表现利于术前做出正确诊断。

Objective To evaluate the imaging features of CT and MR in patients with intraductal papillary mucinous tumor of the pancreas （IPMT）. Methods Imaging findings of 10 patients with histopathologically proved IPMT were retrospectively analyzed. Of 10 cases, CT was performed in 8 patients, and MR in 6 patients. Results Eight lesions were in pancreatic head and neck, and 2 lesions were in pancreatic body and tail. The images showed the dilated pancreatic duct in all the patients, and the diameter was （0,8 ＋ 0.2） cm. Three patients had the dilation of branch duct, and 4 patients showed atrophy of pancreatic body and tail. The CT showed 6 cases had cystic masses with septa and mural nodules; and 2 cases had the dilation of the main pancreatic duct with intraductal mural nodules. Lesions showed low signal intensities on TIWI and high signal intensities on T^WI with septa and mural nodules, which showed moderate hypointensity on T^WI and T^WI and heterogeneous enhancement on enhanced T^WI. Conclusions There are some characteristics in CT and MR manifestation of IPMT： common in pancreatic head and neck, dilated pancreatic duct, cystic tumors with septa and mural nodules, and the enhancement of cystic wall, septa and mural nodules. The disease might be correctly diagnosed with these characteristic imaging features.